Fire needle therapy for moderate-severe acne: A PRISMA systematic review far and meta-analysis of randomized controlled trials

Background: Moderate-severe acne treatment involves the use of isotretinoin and antibiotics as first-line therapeutics; however, these drugs have serious side effects. Fire needle therapy, which is widely used in China, has shown good clinical efficacy for treating moderate-severe acne; moreover, it has fewer side effects, hence, it can be used as a primary treatment (as an alternative to pharmaceutical medications) or in combination with pharmaceutical medications for clinical treatment. However, current clinical evidence regarding its use has not been comprehensively evaluated. Methods: We systematically searched several databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNIU), China Biomedical Literature Service System (SinoMed), China Science and Technology Journal Database (CQVIP), and Wanfang Data Knowledge Service Platform, from their inception time to November 22, 2018. Randomized controlled trials conducted to compare the efficacy, acne recurrence, and adverse events associated with fire needle therapy alone, or in combination with Chinese herbs or conventional pharmaceutical medication, to those of pharmaceutical treatment were selected. RevMan 5.3 software was used to calculate risk ratio (RR) with a 95% confidence interval (CI). Results: Ten trials, with a total of 904 participants, met the inclusion criteria. Meta-analyses showed that fire needle treatment with clindamycin or oral isotretinoin treatment had advantages over pharmaceutical medications alone in the treatment of moderate-severe acne [RR = 2.18, 95% CI (1.19, 3.99), P = 0.03 random model; I-2 = 72%]. Moreover, the use of fire needle therapy alone in the treatment of moderate-severe acne had a better effect than pharmaceutical medications, regardless of the type of pharmaceutical medication used [RR = 2.32, 95% CI (1.77, 3.03), P < 0.00001 random model; I-2 = 59%]. In terms of recurrence rate, there was no significant difference between fire needle and pharmaceutical medication groups [RR = 0.78, 95% CI (0.54, 1.14), P = 0.20 fixed-effect model; I-2 = 0%]. In addition, the use of fire needles was associated with few adverse reactions, such as burning and tingling; furthermore, the adverse reactions were transient. Conclusion: Fire needle therapy alone or combined with other treatments is effective for moderate-severe acne. However, further large-scale, rigorously designed trials are needed to confirm these findings.